title: Optimizing treatment in HIV/HCV coinfection.
abstract: Sustained virological response (SVR) to anti-hepatitis C virus (HCV) treatment is an outcome that can improve life expectancy in persons with human immunodeficiency virus (HIV) infection. Results of anti-HCV treatment are poor, and less than 50% of treated patients show SVR to peginterferon plus ribavirin combination therapy; in infections from HCV genotype 1 this proportion is less than 40%. Pilot studies have demonstrated that Boceprevir or Telaprevir in combination with peginterferon plus ribavirin are able to increase the SVR rate from 45% to 74% with Telaprevir, and from 26% to 61% with Boceprevir in persons never treated for hepatitis C. Interim data seem to indicate a high rate of HCV RNA undetectability on treatment also in patients without sustained response to peginterferon plus ribavirin. Both Telaprevir and Boceprevir have drug-drug interactions with antiretrovirals, and options for concurrent antiretroviral therapy are restricted. There are also several new anti-HCV drugs under study with the potential for more tolerable effective future regimens. The indication for treatment in a patient with HCV/HIV coinfection should take into account the priority of treatment, the probability of sustained response, the potential toxicities, the concurrent antiretroviral therapy options, the patient's motivation, and the sustainability of current and future therapies.
authors.affiliation: Division of Infectious Diseases, AO Ospedale Niguarda Ca' Granda, Milano, Italy. Electronic address: massimopuoti@libero.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: Puoti
authors.forename: Roberto
authors.initials: R
authors.lastname: Rossotti
authors.forename: Giovanna
authors.initials: G
authors.lastname: Travi
authors.forename: Claudia
authors.initials: C
authors.lastname: Panzeri
authors.forename: Marco
authors.initials: M
authors.lastname: Morreale
authors.forename: Erika
authors.initials: E
authors.lastname: Chiari
authors.forename: Giorgia
authors.initials: G
authors.lastname: Cocca
authors.forename: Maurizio
authors.initials: M
authors.lastname: Orso
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Moioli
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use*; D060085:Coinfection / Q000188:drug therapy; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000188:drug therapy*; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D007372:Interferons / Q000627:therapeutic use; D009842:Oligopeptides / Q000627:therapeutic use; D011392:Proline / Q000031:analogs & derivatives / Q000627:therapeutic use; D012254:Ribavirin / Q000627:therapeutic use
chemical_list: D044966:Anti-Retroviral Agents; D000998:Antiviral Agents; D009842:Oligopeptides; D012254:Ribavirin; C486464:telaprevir; C512204:N-(3-amino-1-(cyclobutylmethyl)-2,3-dioxopropyl)-3-(2-((((1,1-dimethylethyl)amino)carbonyl)amino)-3,3-dimethyl-1-oxobutyl)-6,6-dimethyl-3-azabicyclo(3.1.0)hexan-2-carboxamide; D007372:Interferons; D011392:Proline
keywords: 3TC; ATV/r; AUC; Antiretroviral therapy; BOC; Boceprevir; DRV/r; EFV; ETR; Emtricitabine; FPV/r; FTC; HCV; HIV; LPV/r; MSM; NVP; PEG-IFN; PLHIV; RAL; RBV; RPV; Ribavirin; SVR; TDF; TEL; Telaprevir; Tenofovir; area under the curve; atazanavir boosted with ritonavir; cART; combination anti retroviral therapy; darunavir boosted with ritonavir; efavirenz; etravirine; fosamprenavir; hepatitis C virus; human immunodeficiency virus; lamivudine; lopinavir boosted with ritonavir; male having sex with males; nevirapine; peginterferon; persons living with HIV; raltegravir; ribavirin; rilipivirine; sustained virological response